Provider Demographics
NPI:1619524535
Name:CHERILUS, ERILIEN (PA)
Entity type:Individual
Prefix:
First Name:ERILIEN
Middle Name:
Last Name:CHERILUS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6514 SPRING MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-3477
Mailing Address - Country:US
Mailing Address - Phone:561-460-1254
Mailing Address - Fax:
Practice Address - Street 1:714 SUNNY PINE WAY APT A1
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33415-8972
Practice Address - Country:US
Practice Address - Phone:561-460-1254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19-208246ZC0007X
PR2112-P.A.363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant